Management of children with fever and neutropenia: results of a survey in 51 pediatric cancer centers in Germany, Austria, and Switzerland

Abstract

Purpose Investigation of the current practice of diagnostics and treatment in pediatric cancer patients with febrile neutropenia. Methods On behalf of the German Society for Pediatric Oncology and Hematology and the German Society for Pediatric Infectious Diseases, an Internet-based survey was conducted in 2016 concerning the management of febrile neutropenia in pediatric oncology centers (POC). This survey accompanied the release of the corresponding German guideline to document current practice before its implementation in clinical practice. Results In total, 51 POCs participated (response rate 73%; 43 from Germany, and 4 each from Austria and Switzerland). Identified targets for antimicrobial stewardship concerned blood culture diagnostics, documentation of the time to antibiotics, the use of empirical combination therapy, drug monitoring of aminoglycosides, the time to escalation in patients with persisting fever, minimal duration of IV treatment, sequential oral treatment in patients with persisting neutropenia, indication for and choice of empirical antifungal treatment, and the local availability of a pediatric infectious diseases consultation service. Conclusion This survey provides useful information for local antibiotic stewardship teams to improve the current practice referring to the corresponding national and international guidelines. Electronic supplementary material The online version of this article (10.1007/s15010-020-01462-z) contains supplementary material, which is available to authorized users.

Prospective Audit of Gentamicin Drug Monitoring Practice in a Pediatric Cancer Center

“…However, personal communication with the attending pediatric oncology team revealed, that gentamicin was sometimes avoided in light of the additional efforts of therapeutic drug monitoring. This may be a positive side effect considering that many POCs (48 %; 24/50 according to a recent survey) still use ivCoT empirically in all FN patients [21]. The practice of gentamicin combination treatment and drug monitoring is still heterogeneous in pediatric cancer patients with FN [2,4,7,10,19,21].…”

“…A clinically significant benefit of standard ivCoT in all patients with FN has not been demonstrated in clinical trials [15,16,19]. Despite these recommendations, many pediatric oncology centers (POCs) still use a betalactam antibiotic (e. g., ceftazidime, cefepime, piperacillin-tazobactam or meropenem) in combination with gentamicin (or amikacin) as empirical first line treatment [2,7,21]. At our POC, ivCoT (adding gentamicin to piperacillin-tazobactam) is restricted to certain indications, such as previously known colonization with a multidrug resistant gramnegative pathogen (MRGN; in vitro sensitive to gentamicin), FN with transient hypotension responding to IV rehydration, FN with perianal inflammatory lesions).…”

“…In addition to the discussion about indication, appropriate dosing and drug monitoring of aminoglycosides (in terms of measuring peak and trough levels) are two important tasks in clinical practice [8]. Concerning these items, a recent survey revealed high heterogeneity in the participating 51 POCs from Germany, Austria, and Switzerland [21]. Referring to the German pediatric FN management guideline [6], we performed a monocentric prospective audit of the gentamicin drug monitoring practice in our pediatric cancer center.…”

School and kindergarten attendance and home schooling of pediatric cancer patients before and during the SARS-CoV-2 pandemic: results of a survey of the German Society for Pediatric Oncology and Hematology

“…The POCs were arbitrarily categorized into three different size categories, namely small (≤40 newly diagnosed patients/year), medium (41–75), and large (>75) [ 28 ]. Datasets were checked for duplicates from the same center.…”

Antibiotic Stewardship (ABS) in der stationären Kinder- und Jugendmedizin

“…Kommunikation mit Prof. Markus Hufnagel, Freiburg). In einer Umfrage zur Behandlung des Fiebers ohne Fokus bei Patienten mit Granulozytopenie, an der insgesamt 59 pädiatrisch onkologische Zentren aus Deutschland, Österreich und der Schweiz teilgenommen haben [25], gaben 48 % der Zentren an, in dieser sehr häufigen Behandlungssituation immer eine Kombinationstherapie aus einem Breitspektrum-Betalaktam (Piperacillin-Tazobactam, Ceftazidim, Cefepim oder Meropenem) und einem Aminoglykosid zu verordnen. Die aktuelle AWMF-Leitlinie der Fachgesellschaften (DGPI und GPOH) empfehlen in dieser Situation im Regelfall eine Monotherapie [14].…”